2012, 10-23 Permit App: BLD-2012-1902 Plumbing FixturesCommunity Development
Permit Center
11707 E Sprague Ave, Suite 106
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
www.spokanevallev.or2.com
Plumbing Permit Application
SITE ADDRESS: _1 02 S Long
Mail or Fax To: n
Norm's Excavating, Inc. 0 90 .° N
PO Box 574
Veradale, WA 99037
Fax: 892-0432
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PERMIT NUMBER: 6 - i Z
PERMIT FEE: / ,
❑ Commercial ® Residential
AUTHORIZED SIGNATURE:
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REVISED 8/26/05
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DESCRIPTION OF WORK
Building owner
X
COST
Name: Skeen
Phone: 924-1022 Fax:
1
Address: SAME
City: State:
Zip:
Contractor
$6,00
=
Name: Norm's Excavating, Inc
Phone: 509/928-0580
Fax 509/892-0432
Address: PO Box 574
City : Veradale State: WA
Zip: 99037
License No: NORMSEI972BM
City Business License No:
Contact ..:. .
TUBS
Name: Sheila Gibbons
Phone: 928-0580
$6.00
AUTHORIZED SIGNATURE:
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2uiq.eneox3 swJoN
REVISED 8/26/05
et,I:8o zi EZ 400
DESCRIPTION OF WORK
# OF UNITS
X
COST
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
$6,00
=
2
URINALS
X
$6.00
3
TUBS
X
$6.00
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
86.00
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
X
$6.00
6
DISHWASHER
X
$6.00
7
CLOTHES WASHER
X
$6.00
8
GARBAGE DISPOSAL
X
$6.00
9
WATER SOFTENER
X
$6.00
10
ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
$6.00
=
11
FLOOR DRAINS
AREA, CASE, COIL TRENCH, CONDENSATE
X
$6.00
_
12
ROOF DRAINS/OVERFLOW
DRAINS
X
Moo "
13
FOUNTAINS, DRINKING
X
$6.00
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
1
X
$6.00
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
$6.00
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARBONATOR, SWAMP COOLER
X
: '
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR: VATS, TANKS, BOILERS
X
$6.00
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
moo
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
$6.00
=
20
MISCELLANEOUS PLUMBING
FIXTURE
X
$6.00
=
21
PRIVATE SEWAGE DISPOSAUSYS
X
$20.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
$15.00
=
METHOD OF PAYMENT:
0 CASH 0 CHECK I VISA 0 MASTERCARD
Card# See Cover Sheet EXPIRES:
SUBTOTAL
• "
PROCESSING FEE
8.00
TOTAL PERMIT FEE DUE:
14.00
AUTHORIZED SIGNATURE:
s, • d ?rf,n2RRI flq
2uiq.eneox3 swJoN
REVISED 8/26/05
et,I:8o zi EZ 400